To Assess the Effect of Dexamethasone Eye Drops on the Retinopathy of Prematurity Outcome

January 17, 2025 updated by: Region Skane

The Effect of Dexamethasone Eye Drops on Retinopathy of Prematurity, a Swedish Registry-based Study

The purpose is to compare the treatment frequency of preterm infants who developed severe Retinopathy of Prematurity (ROP) during the years 2015-2018 with 2020-2021 in the country, using the statistical method 'difference in differences' to investigate the potential for scientific evidence regarding the introduction of dexamethasone eye drops' effect on the development of severe treatment-requiring ROP. During these years, the investigatots assess that the recommended oxygen saturation levels for preterm infants have remained stable at each clinic, which will serve as its own reference.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Retinopathy of Prematurity (ROP) can develop in premature infants and involves abnormal growth of blood vessels in the retina. It can lead to severe visual impairment or blindness if not treated in time. In Sweden, approximately 40-50 children require treatment for severe ROP each year. Children at the highest risk are screened to detect ROP at an early stage, and, if necessary, laser treatment of the retina is performed or an injection of an anti-vascular endothelial growth factor (anti-VEGF) agent is administered. However, laser treatment burns away the outermost part of the retina, and anti-VEGF carries a significant risk of recurring treatment needs, resulting in increased anesthesia and examination sessions for the child, risk of eye infection, lens damage, and uncertainty about the drug's broader effects on the child's brain or body.

Dexamethasone is a corticosteroid commonly used in eye drop form to treat inflammatory and angiogenic eye diseases. Dexamethasone is also administered systemically in neonatal care to treat lung disease and wean premature infants off ventilator support, often in relatively high doses early in the infant's life.

Increased inflammation in the eyes has been reported in ROP. According to both national and several international guidelines, dexamethasone eye drops are administered in tapering doses after laser treatment for severe ROP, often staring with 1 drop 3 times daily. When a child begins developing severe ROP, it is classified as Type-1 ROP and Type-2 ROP. Type-1 ROP requires treatment within 72 hours, while Type-2 ROP is considered a precursor to Type-1 ROP.

In the Southern Healthcare Region of Sweden, the investigators have initiated earlier use of low dose dexamethasone eye drops, specifically when it appears that the child is transitioning from Type-2 ROP to Type-1 ROP. Usually 1 drop daily. In a pilot study published in September 2021, the investigators observed that only 24% of children who received dexamethasone eye drops at Type-2 ROP progressed to Type-1 ROP, compared to 74% of children who did not receive dexamethasone eye drops for the same type of ROP.

In Sweden, there is a national quality registry for ROP care, SWEDROP, with approximately 98% coverage. The investigators now aim to conduct a study based on this quality registry and compare the results from the Southern Healthcare Region with other regions in Sweden that have not used dexamethasone for Type-2 ROP. The goal is to determine whether the "difference-in-differences" method can provide stronger scientific evidence supporting this treatment approach. The plan is to compare the number of children who progressed to laser treatment in the years before the introduction of dexamethasone for Type-2 ROP with data from 2020-2021, when almost all children in the Southern Healthcare Region, received dexamethasone for Type-2 ROP. Specifically, the investigators will compare the years 2015-2018 with 2020-2021. The year 2019 served as a transitional period in the Southern Healthcare Region, where children were treated with varying doses, and therefore it will not be included in the primary comparison. The treatment frequency will be analyzed both for all screened children and specifically for those who developed severe ROP. Severe ROP is defined as type 1 and type 2 ROP.

Age at treatment will also be analyzed.

Study Type

Observational

Enrollment (Actual)

2017

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Sweden
    • Skane
      • Lund, Skane, Sweden, 22185
        • Department of Clinical Sciences, Ophthalmology, Lund University, Skåne University Hospital, Lund, Sweden

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Between 2015-2018 and 2020-2021, all children born before week 30 in the Southern Healthcare Region and three other regions where dexamethasone eye drops were not used to prevent severe treatment-requiring ROP were included in the study population. A specific analysis was conducted on the children who developed severe ROP, Type 1 and Type 2 ROP.

Description

Inclusion Criteria:

- During 2015-2018 and 2020-2021, all children born before week 30 in the Southern Health Region and three regions where dexamethasone eye drops were not used to prevent severe treatment-requiring ROP were included

Exclusion Criteria:

If a child has not completed the screening examinations for ROP-

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
all screened infants for ROP borne before week 30 in four swedish regions
The treatment frequency for severe ROP was compared between the control years 2015-2018 and the intervention years 2020-2021, but also for all children screened during these years. One region introduced dexamethasone eye drops during the intervention years. The other three regions did not and thus served as a control group.
Drug: Dexamethasone eyedrop
Infants who developed stages of pretreatment-requiring severe ROP were usually given one eyedrop of dexamethasone daily until the ROP changes regressed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Show the clinical effect of dexamethasone eyedrops in reducing treatment-requiring severe ROP
Time Frame: The treatment frequency was compared for the intervention group with the control group during the control years 2015-2018 and the intervention years 2020-2021 when dexamethasone eye drops were introduced in the intervention group.

Has the treatment frequency of severe ROP decreased in the Southern healthcare region compared to other healthcare regions after the introduction of early low-dose corticosteroid treatment in the form of eye drops? Treatment frequency will also be analyzed for all children screened during these years. The statistical method difference in differences will be used in the analyses.

Age at treatment will also be studied to see if the cortisone drops affect this factor.
The treatment frequency was compared for the intervention group with the control group during the control years 2015-2018 and the intervention years 2020-2021 when dexamethasone eye drops were introduced in the intervention group.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Region Skane

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2022

Primary Completion (Actual)

December 31, 2024

Study Completion (Actual)

January 1, 2025

Study Registration Dates

First Submitted

January 9, 2025

First Submitted That Met QC Criteria

January 9, 2025

First Posted (Actual)

March 25, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

January 17, 2025

Last Verified

January 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2022-05824-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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